Emerman C L, Dawson N, Speroff T, Siciliano C, Effron D, Rashad F, Shaw Z, Bellon E L
Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109.
Ann Emerg Med. 1991 Nov;20(11):1215-9. doi: 10.1016/s0196-0644(05)81474-x.
To compare physician judgment in the use of chest radiographs for diagnosing pneumonia with decision rules developed by Diehr, Singal, Heckerling, and Gennis.
Propsective observational investigation with preradiograph survey of physicians' intent to order chest radiographs for patients presenting with respiratory complaints. All patients had uniform clinical data collected, including chest radiographs and sufficient information to retrospectively apply the four clinical prediction rules.
The emergency department and medical outpatient clinic of a major urban teaching hospital.
Adult patients presenting with recent history of acute cough or exacerbation of chronic cough plus either fever, sputum production, or hemoptysis.
Of 290 patients, 21 (7%) had pneumonia. The sensitivity of physician judgment (0.86) exceeded that of all four decision rules. The specificity of the Diehr (0.67), Heckerling (0.67), and Gennis (0.76) rules exceeded that of physician judgment (0.58). The accuracy of the Gennis (0.76) and Heckerling (0.68) rules also exceeded that of the physicians (0.60).
Physicians' diagnostic and therapeutic decisions were characterized by high sensitivity but lower specificity for ordering chest radiographs to diagnose pneumonia. The higher specificity and accuracy of two of the decision rules suggest that they may have a role in patient evaluation.
比较医生在使用胸部X光片诊断肺炎时的判断与迪尔、辛加尔、赫克林和根尼斯制定的决策规则。
前瞻性观察性研究，在进行X光检查前对医生为有呼吸道症状的患者开具胸部X光片的意图进行调查。所有患者均收集了统一的临床数据，包括胸部X光片以及足够的信息以便回顾性应用四种临床预测规则。
一家大型城市教学医院的急诊科和内科门诊。
近期有急性咳嗽病史或慢性咳嗽加重且伴有发热、咳痰或咯血的成年患者。
290名患者中，21名（7%）患有肺炎。医生判断的敏感性（0.86）超过了所有四种决策规则。迪尔规则（0.67）、赫克林规则（0.67）和根尼斯规则（0.76）的特异性超过了医生判断（0.58）。根尼斯规则（0.76）和赫克林规则（0.68）的准确性也超过了医生（0.60）。
医生在诊断和治疗决策中，开具胸部X光片诊断肺炎时敏感性高但特异性较低。其中两种决策规则较高的特异性和准确性表明它们可能在患者评估中发挥作用。
